Khurana
Law Firm

Medicare whistleblower lawyer

Quit tam and whistleblower attorneys battling Medicare and Medicaid fraud in Pennsylvania

Medicaid and Medicare fraud cost Pennsylvania taxpayers billions of dollars annually. Although most medical service providers and drug companies are ethical and work within the legal channels, some do not. When fraud takes place, everybody can lose. Medicaid and Medicare whistleblower lawyers help healthcare professionals to file lawsuits on behalf of the federal or state government to report these kinds of scams.

The federal and state governments put a a good deal of trust in medical and pharmaceutical providers. When that trust is ill-placed, the government relies on regular folks in Pennsylvania to come forward to report scams. People like you.

Work with

Experienced Medicare and Medicaid whistleblower lawyers; representing healthcare workers in Pennsylvania.

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower lawyers, we support your heroic decision to come forward to report abuse and scams in the industry. understand that stepping forward is difficult and lots of things may be at stake. When you come to us, your case is held in the strictest confidence at all times.

With our extensive experience representing whistleblowers nationwide, we completely investigate your claim, diligently and carefully prepare your case, and work relentlessly with you and the state of federal government to assist in bringing fraudulent Medicaid or Medicare activity to justice.

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Whistleblower Laws in Pennsylvania

While taxpayers help fund Medicaid to allow low-income health care for those who need it, there are unscrupulous individuals and companies who defraud the state of Pennsylvania’s Medicaid program through fraudulent activity. These activities have cost the government millions of dollars. State resources dedicated to the discovery of fraud are limited and, consequently, the state must rely on health care providers and others to report any knowledge of fraud. 

 

Under the federal False Claims Act, individuals who know of fraudulent activity against the government have the ability to file a whistleblower lawsuit to hold these parties accountable. Under the Act, an individual who brings a whistleblower claim is entitled to a reward between 15 percent and 25 percent of any recovery, based on their knowledge and contributions. If the government chooses not to intervene in the action, the whistleblower may receive between 25 and 30 percent of the recovery. 

 

Whistleblower laws offer added employee protection to prevent an employer from retaliating, discharging, threatening, or discriminating against a whistleblower.

Liability of the Defendant in Pennsylvania

Violations under the federal False Claims Act may result in fines and penalties in the amount of three times the harm to the government as well as additional penalties of up to $5,500 to $11,000 for each violation.

Statute of Limitations in Pennsylvania

Under the federal False Claims Act, a whistleblower claim must be commenced within 3 years of the date of discovering the fraudulent activity and within 6 years after the activity occurred, whichever occurred later, but not more than 10 years after the activity occurred. 

Working With an Experienced Whistleblower Attorney

If you suspect fraudulent activity concerning the Medicaid program in Pennsylvania, getting guidance from an experienced whistleblower attorney is essential. At Khurana Law Firm, P.C., we will help you determine if you have a valid whistleblower claim and help you understand your rights and options. Contact us for a confidential, no-cost consultation to discuss your case. 

What is

Medicare Advantage Fraud

Medicare Advantage (MA) plans are privately run healthcare options offering Medicare-eligible individuals additional services that are not included in traditional Medicare. These organizations receive payment from Medicare for each of their members that vary according to their risk adjustment. Some Medicare Advantage organizations overestimate and exaggerate a member’s risk or a patient’s diagnoses to get higher payments from Medicare. They do this by:

Upcoding

The MA provider increases the severity of the patient’s condition, submitting a more serious diagnosis code to get paid by Medicare at a higher rate.

Chart reviews

The MA provider reviews charts to add additional diagnosis codes.

Chart mining

The MA provider mines patient’s charts to look for conditions that are not current but can put as current to increase their payments from Medicare.

Adding unsupported diagnosis

Coders are directed to add codes based on other information in the chart.

Not removing old diagnosis codes

The MA provider increases the severity of the patient’s condition, submitting a more serious diagnosis code to get paid by Medicare at a higher rate.

Sham RADV audits

The MA provider reviews charts to add additional diagnosis codes.

Incentivizing doctors

The MA provider mines patient’s charts to look for conditions that are not current but can put as current to increase their payments from Medicare.

Pre-filling charts

Coders are directed to add codes based on other information in the chart.

If you suspect Medicare Advantage Fraud, you can report it here.

Khurana Law Firm, P.C.
Medicare Fraud
Medicare Fraud is a Serious Problem

While there are no exact figures concerning Medicare fraud, we do know it is a huge problem. In the fiscal year 2020, the government recovered over $1.8 billion in civil and fraud claims relating to the healthcare industry. 

$ 0
Recovered only in 2020
YOU, the healthcare worker, provide the most vital role in combating Medicare abuse and fraud.

Watching for fraud and abuse within your organization, practice, or provider’s office helps protect everyone from this taxpayer drain and holds abusers accountable.

So what is Medicare Fraud?

Fraud, as it relates to Medicare, is when individuals or entities make false statements or representations to benefit themselves at the expense of the Medicare program. 

Who defrauds Medicare?

Medicare fraud can involve numerous individuals, organizations, and entities, including physicians and nurses, physician-owned groups, drug companies, home health providers, medical device providers, nursing homes, and others.

How do people and companies commit Medicare fraud?

Fraud and abuse come in many different forms from coding abuses, to kickbacks, to altering records, to organized crime infiltration. Each method benefits the abuser while costing taxpayers billions. 

What laws protect Medicare from fraudulent activity?

The False Claims Act, Anti-kickback Statute, Stark Law, and Federal Criminal Healthcare Fraud Statute hold abusers accountable for their fraudulent activity. 

What government agencies protect against Medicare fraud?

Many government agencies strive to protect and promote the integrity of Medicare. These include the Centers for Medicare and Medicaid Services, Center for Program Integrity, US Department of Health and Human Services, and US Department of Justice, all attempting to keep Medicare fraud at bay. But they rely on people like YOU to be their eyes and ears.

How can I help?

If you see abuse and fraudulent activity you should report it. In some cases, you may even be entitled to a reward. To report Medicare fraud, contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation. 

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Work With A NATIONALLY RECOGNIZED WHISTLEBLOWER LAWYER

If you’ve become aware of potential fraud involving Medicare or Medicaid, you need the advice of a knowledgeable whistleblower lawyer, someone who can make sure that your claim is totally examined and filed accurately and without delay. By dealing with an experienced attorney you are increasing the chance that the federal or state government will step in, hence increasing the possibility for a reward. Reporting Medicare and Medicaid scams is a complex matter –  do not attempt to do this alone, we are here to help.

At Khurana Law Firm, P.C., we bring years of practical experience as national qui tam attorneys to assist in your fight against Medicare and Medicaid scams. Our attorneys will review your case on a confidential, no-obligation basis. If we feel that you may have a legitimate claim, we can represent you in a qui tam suit to report the fraud and allow you to gather a financial benefit. All whistleblower cases are on contingency, you pay absolutely nothing until there is a settlement. Get in touch with us today to to schedule a confidential consultation.

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